Pain and Your Child or Teen

What is pain?

Pain is an uncomfortable sensation, or feeling. It is such an important factor in health that it has been called the “fifth vital sign [1].” It can be constant (always there) or intermittent (coming and going). Pain can be dull and aching, sharp, or throbbing. It can be both physical and mental, and every child experiences it differently. It is important to know that no one can describe what your child’s pain feels like except your child. Pain may be just a nuisance, or it may interfere with your child being able to get through their normal daily activities.

We feel pain when our brain sends out special signals to our bodies. Usually, we are sick or injured when our brains send these signals. Feeling pain usually serves a purpose—it is a signal that something is wrong.

What is the difference between chronic and acute pain?

Pain can be acute (lasting for a short time) or chronic (lasting for a much longer time, perhaps months or years). Chronic pain often goes misdiagnosed. Unlike acute pain, it serves no useful purpose, but rather causes needless suffering if it goes untreated. Untreated or under-treated chronic pain can disrupt family routine, and interfere with your child's daily activities, which can in turn lead to long-term disability. The key to treating chronic pain is doing a good job of recognizing and describing it frequently along the way to ensure that treatment is working as it should [2].

How can I recognize pain in my child? Why is describing pain so important?

Everyone can feel pain, even babies and young children. Kids usually do not remember pain they went through when they were younger than about two years old. Sometimes children have a hard time expressing themselves and may find it hard to tell you where it hurts and what it feels like.

For this reason, doctors and nurses are using new tools to help define pain in the kids they care for. Pain charts and scales for children use pictures or numbers to describe their pain. Describing the pain can help parents and health care providers understand how bad the pain is, and how to best treat it. Talking to your child’s doctors and nurses about pain is important. The more they know about your child’s pain, the more they can help. Pay attention to how your child acts. For example, when your child is in pain, they may be restless or unable to sleep.

Pain can be treated. It can go away! The first step in treating your child’s pain is to tell your child’s doctor or nurse about it. Your health care provider will ask several questions about the pain, including where it hurts, what it feels like, and how it has changed since it started.

Your child’s doctor may ask you to keep a pain diary with your child, which keeps track of when your child has pain throughout the day. This diary can also document how the pain changes after taking pain medications. If medications do not seem to work, or if your child has a bad reaction, tell the doctor and keep a list of these problem medicines for future reference.

Kids in pain do not do as well as kids who keep their pain under control. Pain can slow down your child’s recovery. Also, pain is easier to treat before it gets really bad. So it’s a good idea for your child to keep close tabs on how they feel, so pain can be “nipped in the bud.” If we treat pain right away—before it gets out of control—we find that we actually need less medication overall to get it and keep it under control.

How do I know if I should call the doctor?

Remember: pain is a sign that something is wrong. Call your child’s doctor if your child is in severe pain or has pain that lasts more than one or two days. If your child is in the hospital, let your nurse or doctor know right away if your child has pain.

What about pain medication?

Most pain can be controlled with medications. It is a good idea to combine treatment with medicine with some of the non-drug pain-control treatments listed farther down this page [3]. There are many different kinds of medications that your doctor may want to try to help relieve your child’s pain and discomfort.

If you are giving your child acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) at home, make sure you are giving the correct dose for their size. Check with your child's doctor if you are not sure.

EMLA cream and lidocaine cream are local, topical anesthetic creams that are applied 30 to 90 minutes prior to a needle stick, shot, blood draw, spinal tap or other invasive procedure to numb the area. Parents can apply it at home before going in for the procedure.

In epidural pain relief, pain medication is delivered directly into a tiny tube that is placed in the epidural space in the spine.

If your child is being treated long term pain, you may worry about them becoming addicted to the pain medicine. Don't worry: addiction is very rare. If your child needs pain medications and sedatives for a long time, physical dependence may occur. Physical dependence is not the same as addiction—addiction is a psychological problem. Because of this physical dependence, medication doses will be decreased slowly to prevent possible withdrawal symptoms that can occur if the medicine is stopped suddenly. Nurses and doctors will watch your child carefully for signs of medication withdrawal. Comfort measures as discussed below can be helpful when doses of pain medications are being decreased.

Are there other ways to treat pain besides taking medicine?

Absolutely! Pain is best treated using a variety of non-drug treatments along with medication [3].

One of the most important measures to take is to be there for your child. If your child feels loved and supported, their pain won’t hurt as much. Cuddle, hold, rock, and hug your child. Hold your child’s hand, and let them know you love them. Calm your child, because anxiety makes pain worse. If your child has learned some of the techniques for coping with pain, they may still need you or a nurse to coach them, and remind them what and how to use these techniques. For example, you may need to guide your child in using relaxation techniques, even if your child is already familiar with how to do it [4].

Other examples of non-drug treatments include massage, hot or cold packs, relaxation and guided imagery, distraction, music, hypnotherapy, and reading to your child. It’s a good idea to use many of these techniques together in ways that complement each other. For example, researchers found that using acupuncture and hypnotherapy together was effective at reducing chronic pain and well tolerated by the young people in their study [5]. The experts who can help your child cope with and treat pain may include massage therapists, biofeedback technicians, physician-acupuncturists, child-life specialists, psychologists, and physical or occupational therapists.

Here are some ideas for distracting activities: reading, listening to music, playing video games, playing guessing games, playing board games, watching TV, talking to friends and playing with favorite toys.

Conquering Your Child's Chronic Pain: A Pediatrician's Guide for Reclaiming a Normal Childhood, by Lonnie K. Zeltzer and Christina Blackett Schlank. This book is a guide to how parents can help their children with chronic pain on a daily basis. The author runs a pain clinic, and takes an multidisciplinary approach.

Soothing your Child’s Pain: From Teething and Tummy Aches to Acute Illnesses and Injuries—How to Understand the Causes and Ease the Hurt, by Kenneth Gorfinkle. Addresses using touch, visualization, massage, distraction, and other techniques to treat the pains of teething, stomachache, and illnesses and injuries.

Healing Images for Children: Teaching Relaxation and Guided Imagery to Children Facing Cancer and Other Serious Illness, by Nancy Klein.Presents relaxation techniques, describes medical interventions at a child's level of comprehension, and tells stories to teach ways to reduce pain and stress. The first section is for adults and the second section is for kids.

A Boy and A Bear: The Children's Relaxation Book, by Lori Lite.Written for ages 3-10, this book teaches kids how to relax and calm themselves through an engaging story.

The Relaxation & Stress Reduction Workbook, by Martha Davis, Matthew McKay and Elizabeth Robbins Eshelman.This is a thick book written for adults, but the techniques and exercises in it could be adapted by parents for their child to use to relax when facing pain.

Pain in Infants, Children, and Adolescents, by Neil Schechter, Charles Berde and
Myron Yaster.This is the definitive text for professionals on pain in children and youth.

What about videos about kids and pain?

No Fears, No Tears, produced by Leora Kuttner for the Canadian Cancer Society.In the mid-1980's, clinical psychologist Leora Kuttner spearheaded a pioneer pain management project for children with cancer. In No Fears, No Tears eight courageous children with cancer, aged three to twelve years old, demonstrate a variety of ways in which the natural abilities of the mind can be enlisted to help ease physical pain. With the support of parents and caregivers, they show how hypnosis, behavioral distraction and visualization methods, and breathing techniques can make the disease itself, as well as the long series of uncomfortable or painful tests and treatments, bearable.

No Fears, No Tears, 13 Years Later -Children Coping With Pain, produced by Leora Kuttner. Kuttner revisits seven of the same children thirteen years later, to explore the long-term impact of having learned as a child how to deal with fear and pain.

How can I find more information and support?

YourChild:Pain and Your Infant covers how to help your baby cope with the pain of medical procedures, circumcision, and teething.

Pediatric Pain Management is written for staff education, but will be useful for parents, as well. It includes information about assessing pain in infants and children, classifying types of pain, treating pain with medication and non-drug approaches, and addiction and dependence to pain medications.

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